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Erythema Multiforme

Definition

Erythema multiforme is a skin condition often associated with an overreaction to an infection or medication. It can affect skin throughout the body. Erythema multiforme has two forms:

Erythema multiforme minor—most common, is generally mild and may go away on its own

Erythema multiforme major—rare, usually more severe, less likely go away on its own, and can be life threatening

Causes

Erythema multiforme is an overreaction of the immune system to a certain trigger. Some erythema multiforme is associated with an infection or certain medications, though the exact trigger is not always known. It is not clear why some people have this reaction.

Symptoms

Symptoms can vary from mild to severe. Both erythema multiforme minor and major cause skin lesions that:

Are itchy or burning

Typically develop over 3-4 days, but at different times. Lesions will look different in various places of the body.

Often start on hands and feet and spread to legs, arm, and face

Start out as small, red areas, and grow to circular, raised areas. The middle is often a dark red which fades to a pale pink and is surrounded by a bright red edge. The different colors make the lesions look like mini targets.

May have a blister or crust in the center

Appears equally on both sides of the body

May develop in one mucus membrane such as the lips, inside the mouth, or the eyes

Erythema multiforme major may also cause:

General ill feeling, fever, and achy joints before the rash appears

More extensive rash

Lesions that develop in 2 or more mucus membranes such as the lips, inside the mouth, or the eyes

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. You may be referred to a doctor who specializes in skin problems (dermatologist).

Most cases can be diagnosed based on your medical history and skin exam. The target lesions are usually a key for diagnosis. However, the skin lesions may not be typical and a sample of the skin may be taken. The skin sample is examined under a microscope to look for findings of erythema multiforme.

Treatment

Erythema multiforme will usually go away on its own in 4-6 weeks. Mild forms usually will not need treatment.

Treatment may be needed to treat an underlying infection. This may include antiviral, antibiotic, or antifungal medications. If the erythema multiforme is related to a current medication, your doctor will work with you to stop the medication and find a replacement if needed.

Severe lesion due to erythema multiforme major may also require:

Treatment to prevent infections of the lesions

Hospitalization for widespread, life-threatening lesions

Management of Symptoms

Moist compresses and medications may help relieve discomfort from lesions. Medication options may include:

Oral antihistamines to help control itching

Topical steroid creams to help discomfort and itching

Acetaminophen
to reduce pain and fever

Medicated mouthwash for lesions in the mouth

Medications

Steroids, or steroid-sparing medications may be needed with widespread erythema muliforme major. These medications suppress or enhance the immune system and may decrease the intensity or halt the lesions. These may be given orally or through an IV.

Prevention

If the lesions were due to the herpes simplex virus, there are ways to prevent outbreaks:

Talk to your doctor about a daily prescription of an oral antiviral medication.

Apply sunscreen and zinc sulfate solution to the site of the herpes simplex to help prevent relapse.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.